Child and Adolescent Health Social Epidemiology Gabriela Kšiňanová 2021 Outline 1.Burden of disease in child and adolescent populations 2.Childhood social circumstances and health 3.Prevention of child and adolescent mortality and morbidity 4. Burden of Disease in Children and Adolescents 1.Non-communicable diseases (NCDs) •E.g., cardiovascular diseases, cancers, mental and substance use disorders •Typically low in children and adolescents (less than 10% of world DALYs) 2.Communicable, maternal, neonatal and nutritional diseases •E.g., diarrhea, lower respiratory & other common infectious diseases, HIV/AIDS, nutritional deficiencies •Major source of disease burden in this age group (over 60% of world DALYs) 3.Injuries •E.g., road injuries, falls, drowning, self-harm, interpersonal violence, conflict & terrorism, natural disasters •Less than 20% of world DALYs in children and adolescents • Burden of Disease Globally •Global rates are driven by: 1.conditions affecting the youngest children •Under 5 years old, particularly newborns 2.mortality in regions with low socio-demographic index (SDI) •Sub-Saharan Africa •Central and Southern Asia 3.by communicable, maternal, neonatal and nutritional diseases •Prevalent particularly in low SDI regions • 4. Burden of Disease by Age and Region •Drivers of health loss in low SDI regions •Mortality due to communicable, maternal, neonatal and nutritional diseases •Drivers of health loss in high SDI regions •Nonfatal health loss •Greater role of NSDs and injuries • •Differences between the regions are more pronounced with increasing age of the children •DALYs decreased across the world (particularly in children under 5); however income and disadvantage-related inequalities persist •DALYs in older children, adolescents and those due to nonfatal health outcomes (NCDs, incl. acquired chronic conditions with childhood onset) decreased less Childhood Social Circumstances and Health •Childhood adversity have lasting impact of physical and mental health • •Childhood socioeconomic status (SES)/poverty •Adverse childhood experiences (ACEs) • •STRESS • Childhood Poverty and Health Inequality Pathways of Influence Childhood Poverty and Health Levels of Influence •Biological •Ongoing elicitation of the stress reaction alters endocrine, metabolic, and immune systems •Epigenetic effects •Psychological •Weaker sense of control over the environment •Adopting health threatening behaviors •Community and country •Distribution of wealth and social mobility •Welfare state Childhood Poverty and Risk for Disease •Low birth weight and increased infant mortality •Greater risk of injuries •Accidents •Physical abuse/neglect •Higher risk for asthma •Lower developmental scores •Metabolic diseases (obesity, diabetes) •Mental health problems • Adverse Childhood Experiences (ACEs) and Health Adverse Childhood Experiences •ACEs, particularly their accumulation (4+) are correlated with SES •However, ACEs are prevalent in all social strata •Over 50% of general population report at least 1 ACE •Between approx. 6% - 14% report exposure to 4+ ACEs •Most common: emotional abuse/neglect, parental •divorce/separation, household substance abuse •Least common: sexual abuse, incarceration •of family member •Impact on health via exposure to chronic stress •Biological and psychological mechanisms • •Experiencing 4+ ACEs was associated with greater risk for disease in adulthood (19-92 years) •E.g., 4+ ACEs were associated with 2.2 times greater likelihood of developing cardiovascular disease Preventing Morbidity and Mortality •Prevention, interventions and policy change to address: •Child and adolescent morbidity and mortality •Adult morbidity and mortality due to conditions originating in childhood and adolescence •Affecting causal pathways that lead to development of the disease Preventing Morbidity and Mortality Example of Safe to Sleep Campaign •The problem •Sudden Unexpected Infant Death (SIDS) is among the leading causes of infant mortality in developed countries •SIDS = unexplained death of an infant under age 1 •Prevalence in the United States was 130.3 deaths per 100,000 live births in 1990 •Potentially preventable deaths? Preventing Morbidity and Mortality Example of Safe to Sleep Campaign •SIDS risk factors: •Sex of the baby •Ethnicity and SES of the family •Prematurity •Family history •But also: •Stomach sleeping •Bed-sharing •Exposure to secondhand smoke • • Risk factors modifiable by an intervention • • Multilevel Interventions •Implementation of Safe to Sleep at different levels of influence •Including safe sleep guidelines to education of nursing students •Addressing cultural practices related to infant sleep (e.g. bed-sharing) •Educating parents on safe infant sleep • Summary 1.Burden of disease in child and adolescent populations •Global DALYs driven by under 5 mortality due to communicable, maternal, neonatal and nutritional diseases •Large differences between regions in causes and number of DALYs 2.Childhood social circumstances and health •Childhood adversity have lasting impact of physical and mental health •Adversity such as childhood poverty and ACEs present chronic stress that leads to increased morbidity and mortality 3.Prevention of child and adolescent mortality and morbidity •Prevention of health loss in children/adolescents as well as later in the lifespan •Multilevel interventions to increase the chance for success • Thank you •for your attention!